家庭医生主动健康管理模式对社区原发性高血压合并慢性失眠症的干预效果研究

Efficacy of intervention with active health management model for hypertensive patients with chronic insomnia in the community

目的探索家庭医生主动健康管理模式对社区原发性高血压合并慢性失眠症患者的效果。方法选取2020年9—10月上海市普陀区石泉街道社区卫生服务中心全科门诊的符合纳入和排除标准的200名原发性高血压合并慢性失眠症患者,随机分成试验组和对照组,每组100例。试验组根据高血压分级分层进行主动健康管理和常规管理;对照组按照《中国高血压基层管理指南(2014年修订版)》相关规范仅进行常规管理。干预期为2020年11月—2021年4月。两组在干预前完成基本资料(姓名、性别、年龄、身高、体重、血压)和生化指标(血糖、血脂、肾功能)的搜集,在干预前及干预3、6个月后均进行匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、广泛性焦虑自评量表(GAD-7)和抑郁症筛查量表(PHQ-9)的填写。结果经过3个月管理后,试验组在睡眠质量、入睡时间、睡眠效率、睡眠障碍和日间功能评分低于基线评分,试验组睡眠效率改善优于对照组(P<0.05);经过6个月管理后,两组睡眠各因素评分都有所降低,但试验组降低更明显。管理6个月与管理3个月相比,对照组睡眠质量、入睡时间、睡眠效率、催眠药物和日间功能明显改善(P<0.01),睡眠时间评分有所降低(P<0.05);试验组睡眠各因素评分明显改善(P<0.01)。两组PSQI、ISI和收缩压(SBP)组间效应和时间效应差异有统计学意义(P<0.05)。管理3个月后,对照组与基线比较,PSQI总分、SBP和舒张压(DBP)差异有统计学意义(P<0.05),试验组与基线比较,SBP、睡眠情况和焦虑抑郁症状总分差异有统计学意义(P<0.05),试验组SBP、PSQI和ISI总分减少明显优于对照组;管理6个月后,与基线比较,对照组SBP、睡眠情况和焦虑抑郁症状总分较基线明显减少(P<0.05),试验组血压、睡眠情况和焦虑抑郁症状总分与均较基线明显降低(P<0.05),试验组除了DBP外,其余均明显优于对照组(P<0.01);两组管理6个月和3个月比较,除了DBP,试验组的量表评分减少和SBP的降低均优于对照组(P<0.01)。结论通过慢性病的主动健康管理模式可以明显改善患者的焦虑抑郁情绪、失眠和血压情况,可以减少社区慢性疾病并发症的发生发展,本研究为社区的健康管理模式的选择提供一定的理论依据。

Objective To efficacy of intervention with active health management mode for hypertensive patients with chronic insomnia in the community.Methods Two hundred hypertensive patients with chronic insomnia who visited the General Practice Clinic of Shiquan Community Health Service Center were randomly divided into two groups with 100 cases in each group.Patients in study group received individual active health management and patients in control group received routine management from November 2020 to April 2021.The baseline clinical data and biochemical indexes were collected in both groups before intervention.Pitts burgh Sleep Quality Index(PSQI),Insomnia severity index(ISI),Generalized Anxiety Disorder(GAD-7)and Patient Health Questionnarie-9(PHQ-9)were assessed in both groups at 0,3 and 6 months after intervention.Results After 3 months of intervention,the scores of sleep quality,sleep latency,sleep efficiency,sleep disorder and daytime function of PSQI scores in study group were significantly lower than the baseline scores,and the improvement of sleep efficiency in the study group was better than that in the control group(P<0.05).After 6 months of management,PSQI factor scores were reduced in both groups,but the decrease was more significant in the study group.Compared with 3 months,the sleep quality,sleep latency,sleep efficiency,sleep medicine use and daytime function in the control group after 6 months of management were significantly improved(P<0.01),and the sleep time score was decreased(P<0.05).The scores of PSQI factors in the study group were significantly improved(P<0.01).There were significant differences in the effect and time effect of PSQI,ISI and SBP between study group and control group(P<0.05).After 3 months of management,the PSQI total score,SBP and DBP in the control group were significantly different from those of the baseline(P<0.05);the systolic blood pressure,sleep status and the total score of anxiety and depression symptoms in study group were significantly different from those of the baseline(P<0.05),the total scores of PSQI,ISI and SBP in the study group were significantly lower than those in the control group.After 6 months of management,the systolic blood pressure,sleep status and total score of anxiety and depression symptoms in the control group were significantly decreased compared with baseline(P<0.05);the blood pressure,sleep status and total scores of anxiety and depression symptoms in the study group were decreased compared with baseline(P<0.05);all the indicators in the study group were significantly better than those in the control group,except DBP(P<0.01).Conclusion The active health management mode can significantly improve the anxiety and depression,insomnia and blood pressure of patients,and can reduce the occurrence and development of complications of chronic diseases in the community.